MEDICAL RECORD 
CONTINUATION SHEET for either: 
NIH 2514-1, Consent to Participate In A Clinical Research Study 
NIH 2514-2, Minor Patient's Assent to Participate In A Clinical Research Study 
STUDY NUMBER CONTINUATION: page ^ of ^pages. 
A tentative agreement to an autopsy. 
In case of death during or after your participation in this research study, we ask you for a tentative 
agreement to an autopsy. This will provide us with an opportunity to learn more about the effect of 
our treatment of your tumor. 
Alternative Treatments: 
You have been offered the opportunity to participate in this study, after your tumor recurred despite 
appropriate standard therapies for your disease. There are no other standard treatments that were 
shown to have significant effects in patients with your disease, You may or may not have received 
chemotherapy for the treatment of your brain tumor. Chemotherapy is sometimes used for the 
treatment of primary brain tumors, but its effect is usually considered marginal. A variety of 
experimental studies for the treatment of brain tumors are conducted in medical centers around the 
world, but the efficacy of their approaches is as yet unknown. In addition, there is always the 
possibility for you to decline any further treatment for your disease. 
. 
Financial Considerations 
You will not receive any payment for participation in this study. 
Policy on Compensation for Injuries Related to Research 
The Clinical Center will provide short-term medical care for injuries resulting from your 
participating in research. Neither the Clinical Center nor the Federal Government will provide 
financial compensation or long term medical treatment for such injuries, except as may be provided 
through whatever remedies are normally available under law. 
PATIENT IDENTIFICATION 
CONTINUATION SHEET for either 
[ 830 ] 
NIH-2514-1 (10-84) 
Recombinant DNA Research, Volume 15 
